Root perforation is a mechani­cal, iatrogenic or pathologic communication between the root canal system and the external tooth surface. An iatrogenic perfora­tion often results from misalignment of burs or engine-driven instruments during endodontic access prepara­tion, canal negotiation or root canal preparation. Some iatrogenic perfora­tions are created during prosthodontic treatment, in particular when pre­paring a post space.

One study stated that 47% of perfora­tions were noted or created during endodontic treatment, while 53% were due to prosthodontic treatment; maxillary teeth (74.5%) were more often affected than were mandibular teeth (25.5%). Root perforation may lead to complications that necessi­tate extraction of the involved tooth. 

A 2011 prospective study suggested that 4.2% of endodontically treated teeth were extracted because of iat­rogenic perforations and stripping. Bacterial infection emanating from the root canal, the periodontal tis­sues or both prevents healing and brings about inflammatory sequelae including pain, swelling, suppuration and bone resorption. Down-growth of the gingival epithelium to the per­foration site can follow, resulting in accelerated periodontal breakdown. 

Siew et al from the University of Hong Kong, China, conducted a sys­tematic review of reported treatment, outcomes of repaired root perforations to identify any preoperative factors that may influence the outcome of such repair. A comprehensive search was conducted using 4 elec­tronic databases (PubMed, Web of Knowledge, EMBASE and SCOPUS) as well as a manual search of cited references to identify reports related to root perforation.

All relevant articles published from 1950 to the middle of 2014 that evaluated the outcome of repaired root perforations were identified. Studies were further screened for similar characteristics so that pooling of data could be used for meta-analysis. 

A total of 17 studies were included in the systematic review; 12 studies were included in the meta-analysis. An overall pooled success rate of 72.5% (95% confidence interval [Cl], 61.9%-81.0%) was estimated for repair of root perforations. The use of mineral trioxide aggregate appeared to enhance the success rate to 80.9% (95% Cl, 67.1%—89.8%), but the difference was insignificant. The presence of preexisting radiolucency adjacent to the perforation site predicted a lower chance of success after repair (p < .021). Maxillary teeth demonstrated a significantly higher success rate than did man­dibular teeth (p < .05).


The overall success rate of >70% led the authors to conclude that non- surgical repair of root perforation should be the preferred treatment option when this complication arises during root canal therapy. Teeth in the maxillary arch and ab­sence of preoperative radiolucency adjacent to the perforation are favorable factors for healing after perforation repair.

Siew KL, Lee AHC, Cheung GSP. Treat­ment outcome of repaired root perforation: a systematic review and meta-analysisEndFragment